Carlos Henrique Assunção Paiva

Reforma sanitária e a criação do Sistema Único de Saúde: notas sobre contextos e autores.

Within the context of the return to democracy, the new constitution enacted in 1988 transformed health into an individual right and initiated the process of creating a public, universal and decentralized health system, profoundly altering the organization of public health in Brazil. This article discusses the main institutional, political and social aspects of this health reform, along with the changes, the continuities and the major initiatives, based on the literature published by the most widely read authors in this field of study. Without purporting to offer an exhaustive analysis, we discuss how the historiography written by authors who were also actors in the process assess its main features, along with the genesis of the process and the legacy of health reform in Brazil.

A burocracia no Brasil: as bases da administração pública nacional em perspectiva histórica (1920-1945)

Este artigo se dedica a discussao, em perspectiva historica, do desenvolvimento de modelos de administracao publica classicos e do fenomeno da burocratizacao no pais. Em um primeiro momento, sera apresentado o fenomeno burocratico em suas perspectiva mais global, relacionando-o a processos de mudancas sociais, em certo sentido globais e genericos, como a industrializacao e a urbanizacao. Em um segundo momento, sera discutido o fenomeno da burocratizacao em uma perspectiva denominada micro, ao destaca-lo em sua dimensao politico-administrativa. Procuraremos, entao, investigar o processo de decisoes e gerenciamento estatais que constituem a substância das reformas administrativas implementadas a partir dos anos 1930 ate o final da gestao Vargas em 1945. Este periodo coincide com uma serie de reformas politico-administrativas que mudou, definitivamente, a relacao entre estado/sociedade, bem como as relacoes sociais no âmbito da maquina publica no Brasil.

Cooperação internacional e políticas de ação afirmativa: o papel da Organização Pan-Americana da Saúde (OPAS)

The article analyzes the formulation, legitimation, and implementation of a policy with an ethnic/race approach by the Pan American Health Organization (PAHO). The study includes the emergence of the theme within this international organization, the institutional dynamics related to it, and the proposals focused on the Black population in Latin America. These issues are discussed on the basis of interaction between PAHO and a range of intergovernmental agencies and private organizations working in the international health domain. Participation by PAHO in the ethnic/racial theme provides elements for understanding the dual role played by intergovernmental organizations in the new global scenario, as both social actors and arenas. As an important social actor in the international health field, PAHO has produced and disseminated values and guidelines related to the ethnic/racial theme. As an arena, the organization has proven open to various interests, seeking to work harmoniously with them through its internal administration.

A internacionalização da saúde: elementos contextuais e marcos institucionais da cooperação brasileira

The article contextualizes the emergence of an international policy for the Brazilian Unified Health System as the common agenda of the Pan American Health Organization (PAHO) and the Brazilian Ministry of Health. For this purpose, two contextual axes were explored throughout the work. The first discusses the explicit relationship between the development-cooperation-health triad from an international perspective. The second examines the recent evolution of Brazilian foreign policy, particularly with respect to the role it is playing in South-South cooperation on health matters. The contextual framework that defines Brazilian international cooperation with PAHO is emphasized, above all with regard to the implementation of a specific cooperation agreement. The article concludes that this agreement, within the framework of South-South cooperation, is one of the principal institutional mechanisms established to bring about technical cooperation in health in the current setting.

The Juscelino Kubitschek government and the Brazilian Malaria Control and Eradication Working Group: collaboration and conflicts in Brazilian and international health agenda, 1958-1961

Malaria, a disease which was under control in the beginning of Juscelino Kubitschek government, became the most important endemic disease in 1958, when Brazil made a commitment with the World Health Organization to convert its control programs into eradication programs. For this purpose a Malaria Control and Eradication Group was set up under the leadership of the malaria specialist Mário Pinotti. Malaria would become an important bargaining chip in the context of the development policies of Kubitschek. This article focuses on path of the Malaria Control and Eradication Working Group in Brazil, in its varying relationships with the arguments and guidelines established at international level.

Izabel dos Santos e a formação dos trabalhadores da saúde

This article discusses the career of Izabel dos Santos (1927-2010) as a means of examining the connections between health schools and agendas in contemporary Brazil. The article highlights dos Santoss training and her work in the Servico Especial de Saude Publica (SESP- Special Public Health Service), the Pan American Health Organization (PAHO) and in the formulation and implementation of national training programs for human resources within the area of health from the late 1970s onwards. The article highlights dos Santoss central role in the formulation and implementation of training policies for health workers, especially nursing technicians and assistants, and demonstrates how she occupies an important place in the history of Brazilian public health.

Na Baixada Fluminense, à sombra da ‘Esfinge do Rio’: lutas populares e políticas de saúde na alvorada do SUS

This paper addresses the popular health movement in Nova Iguaçu-RJ in the 1970s and 1980s. Amidst political repression, residents organized themselves to find solutions to various problems, including health problems. Health demands are enhanced both by the dengue epidemic and linkages with the Brazilian health reform and a struggle for democracy. Using documental historical sources from newspapers, health dissemination papers and documents from the House of Oswaldo Cruz-Fiocruz collection, this paper concludes that the example of Nova Iguaçu reveals both the complexity of the process of political opening at the local level and efforts of conducting a health reform where it was needed the most. Resistance on the part of the medical corporation, private interests in health and the existence of a still incipient popular political organization and culture are some of the elements that account for the hardships in advancing the manifest wishes of policies. The specificities of local arenas also point to possible institutional arrangements, sometimes very peculiar and not reproducible in other settings.Resumo O artigo revisita o movimento popular por saude em Nova Iguacu-RJ nas decadas de 1970 e 1980. Em meio a repressao politica, moradores se organizaram para encontrar solucoes para diversos problemas, entre eles os da saude. A luta pela saude se potencializa tanto pela epidemia de dengue quanto pelas conexoes com a reforma sanitaria brasileira e pela democracia. Com apoio de fontes documentais provenientes de jornais diarios, artigos de divulgacao em saude e do acervo da Casa de Oswaldo Cruz-Fiocruz, o artigo conclui que o exemplo de Nova Iguacu e revelador tanto acerca da complexidade do processo de abertura politica em âmbito local quanto dos esforcos de conducao de uma reforma sanitaria onde ela se fazia mais necessaria. A resistencia de parte da corporacao medica, os interesses privados na saude, a existencia de uma cultura politica popular ainda incipiente e um associativismo em formacao sao alguns dos elementos que dao conta das dificuldades em se fazer avancar os anseios manifestos no plano das politicas. As especificidades das arenas locais, tambem apontam para as possibilidades de arranjos institucionais, por vezes, muito peculiares e nao reproduziveis em outros cenarios.

The World Health Organization Framework Convention on Tobacco Control in the Brazilian political agenda, 2003-2005

This study analyses the development of a tobacco-control agenda in Brazil following the countrys participation in the World Health Organization Framework Convention on Tobacco Control (WHO-FCTC). This process started with the diplomatic negotiations for the participation of Brazil in the treaty, in 2003, and its ratification by the National Congress, in 2005, and was marked by substantial controversies between public health players, who are accountable for tobacco-control actions, and the high echelon of Brazilian diplomacy, emissaries of the tobacco industry, representatives of small tobacco farmers from the Southern region of the country, congress representatives, senators and ministers. The study is based on the contributions of John W. Kingdon on the development of an agenda for the formulation of public policies. It took into account secondary references, legislative and institutional sources from the 1995 to 2005 period. It concluded that the association of tobacco-related healthcare actions by technically skilled officials, the involvement of the high echelon of the Ministry of Foreign Affairs (policy flow), the initiative for the establishment of the WHO-FCTC (problem flow), and the existence of a favorable environment in both, executive and legislative (political flow), opened a window of opportunity for WHO-FCTC ratification and its inclusion in the government decision agenda.

El Convenio Marco para el Control del Tabaco en la Organización Mundial de la Salud em la agenda política brasileña, 2003-2005

This study analyses the development of a tobacco-control agenda in Brazil following the countrys participation in the World Health Organization Framework Convention on Tobacco Control (WHO-FCTC). This process started with the diplomatic negotiations for the participation of Brazil in the treaty, in 2003, and its ratification by the National Congress, in 2005, and was marked by substantial controversies between public health players, who are accountable for tobacco-control actions, and the high echelon of Brazilian diplomacy, emissaries of the tobacco industry, representatives of small tobacco farmers from the Southern region of the country, congress representatives, senators and ministers. The study is based on the contributions of John W. Kingdon on the development of an agenda for the formulation of public policies. It took into account secondary references, legislative and institutional sources from the 1995 to 2005 period. It concluded that the association of tobacco-related healthcare actions by technically skilled officials, the involvement of the high echelon of the Ministry of Foreign Affairs (policy flow), the initiative for the establishment of the WHO-FCTC (problem flow), and the existence of a favorable environment in both, executive and legislative (political flow), opened a window of opportunity for WHO-FCTC ratification and its inclusion in the government decision agenda.

A Convenção-Quadro para o Controle do Tabaco da Organização Mundial da Saúde na agenda política brasileira, 2003-2005

This study analyses the development of a tobacco-control agenda in Brazil following the countrys participation in the World Health Organization Framework Convention on Tobacco Control (WHO-FCTC). This process started with the diplomatic negotiations for the participation of Brazil in the treaty, in 2003, and its ratification by the National Congress, in 2005, and was marked by substantial controversies between public health players, who are accountable for tobacco-control actions, and the high echelon of Brazilian diplomacy, emissaries of the tobacco industry, representatives of small tobacco farmers from the Southern region of the country, congress representatives, senators and ministers. The study is based on the contributions of John W. Kingdon on the development of an agenda for the formulation of public policies. It took into account secondary references, legislative and institutional sources from the 1995 to 2005 period. It concluded that the association of tobacco-related healthcare actions by technically skilled officials, the involvement of the high echelon of the Ministry of Foreign Affairs (policy flow), the initiative for the establishment of the WHO-FCTC (problem flow), and the existence of a favorable environment in both, executive and legislative (political flow), opened a window of opportunity for WHO-FCTC ratification and its inclusion in the government decision agenda.